HomeMy WebLinkAboutDrain Layers Permit 12 Gardinia Lane TOWN OF SOUTH W1 N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
&'tX—d "�
DRAIN LAYER'S PERMIT 5577'�,�
19g1
Pursuant to written application, permission is 4ereby granted to the Licensed Drain Layer
named herein to perfo the work hLind I ted below at tie � 2�ro�lc d �, o'T" Z
at premises owned by 6(-06i-i fh), ! .c r f whose address is
r 0-7 l,�j `7- T0(-J s 1 4JOr'�'3 and to
Lay House Drain, ✓ Repair House Drain, Lay Main, Other ,
for occupancy or use, with 5 �4Ie
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE ("), INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
Aeovc'D
SPECIAL CONDITIONS
Desired Starting Date It i Estimated Time for Completion uJ
Permit to be issued o AVML � SE��1t S jUc
the holder of Drain Layer's License No. i Permit will expire thirty (30) days
after date of issuance. The undersigned Drain Layer hereby agrees to all the terms and
conditions set forth in the permit and the reverse side thereof. Applicant has received
Town Permit No. and/or CHD Permit No.
Signed
Licensed Drain Layer
The above named Drain Layer has a valid license is d by the State of Connecticut and
has filed a satisfactory bond and insurance policy in� he ame of t e Town of South Windsor:
i l
/ E gi ering artment Date
a Paid
Connection Char l � �/ J r(�
g `�, Permit ee: Paid $
tck umber ®Zlo g34-
Issued by
Tax Off ice
r . -
INSPECTION c
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED•
Inspector pate
N
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
c
DATE OF CONSTRUCTION:
BUILDING ADDRESS OR LOT N' :
STREET: (06RDE81fq LA.jqc
SUBDIVISION: fEI) {UDKE
C) 1.
NH STATION : Lq + S y
NORTH ARROW INVERT ELEV: a�J(v• q �
TIE TIE
-FT ► -FT
HOUSE __ LATERAL L:OTERAL HOUSE
CONNECTION STUB STUB CONNECTION
FT 13 60 FT.
BUILDING INV. ELEV. INV ELEV. INV. ELEV. INV. ELEV.
(IF EXIST.) ►` � ,oe- BUILDING
,L (IFEXIST.)�--
/' 1 �rCX1T�4& i4v. mci
i346) (cx,5nd&)
TIE TIE
L.Q, ZS51 12t fT. NH STATION : /3 + 36
�h,l� irrJ, fry = IZS��1
C5£ ER� iN�. BUT= 12�.28 (OQfr«�R�oe INVERT ELEV: 12f7.36
(bmUek coA5MucTIffrJ fl{16E vc&4nor►
CONTRACTOR (PRINT) NAME FCONTRACTOR'S SUPERVISOR (PRINT)
4-1 s�lrrr mg2c c►Ru.e 170 C�FRocI�6 K4. - /
STREET ADDRESS SIG DATE
S.L4)I4o5aP. ,cl- l &2_(�A}y I CT
C TOWN STATE ZIP INSPECTED BY TOWN DATE
( Za3 ) 52.8-73z-3 / �59-ZSOI
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER